Exam Flashcards
1
Q
3 periods of stress
A
-As a physiologic response
-As a Stimulus
-As a Person–Environment Transaction
2
Q
allostasis
A
-maintaining stability through change
-Describes how the cardiovascular system adjusts to resting and active states of the body
-different environmental circumstances or conditions require different set points
-Maintaining an allostatic balance in wide-ranging circumstances calls for continuous systemic adjustments throughout the whole body
3
Q
allostatic load
A
- the cumulative negative effects on the body of continually having to adapt to changing environmental conditions and psychosocial challenges
- it is the sum total of the “wear and tear” on the body that accumulates from the constant effort required to maintain normal body rhythms in the face of change and stress
4
Q
stress as a physiological response
A
environmental changes are perceived as threats to personal integrity or safety and signal a compensatory response mediated by the sympathetic branch of the autonomic nervous system
5
Q
adaptation syndrome
A
-stress (a nonspecific response of the body to any demand placed on it)
-stressors (events that initiate the response)
-can be physical (e.g., infection, intense heat or cold, surgery, debilitating illnesses)
-psychological (e.g., psychological trauma, interpersonal problems)
-social (e.g.,lack of social support).
-short term (acute) or long term (chronic).
6
Q
automatic responses to stress
A
1) alarm reaction → all body systems respond to mediate the stressor, if successful the body returns to normal, if not successful and stressor continues the body moves into resistance
2) Resistance → efforts to adapt continue
3) Exhaustion → when stressor becomes chronic or extreme, individuals resources are depleted
7
Q
Recent life changes questionnaire (RLCQ)
A
Family
Personal
Work
Financial
8
Q
Stress as a Person Environment Transaction
A
-stress as resulting from a perceived imbalance between an individual’s resources and the demands placed on them
-stress depends on how a stressor is appraised in relation to the individual’s resources for coping with it
9
Q
cognitive appraisal
A
-the process by which individuals examine the demands and constraints of a situation in relation to their own personal and network resources
-Primary - individuals evaluate the situation and determine whether they are in danger or under threat
-Secondary - the individual considers the options for dealing with the situation
10
Q
Physiological Stress Response
A
-The physiologic response to stress begins in the central nervous system (CNS) but quickly involves all body systems.
-Sympathetic response
-hypothalamic–pituitary–adrenocortical (HPA) axis and the sympathetic–adrenal medullary system
-Corticotropin releasing hormone → adrenocorticotropic hormone → cortisol
-Immune system functioning affected negatively
-Over time, biologic responses to stress compromise a person’s health status
11
Q
structural social support
A
quantitative characteristics of social support network (size, number of connections)
12
Q
functional social support
A
quality of relationships, degree to which one believes help is available
13
Q
dissupport
A
some relationships can be harmful, stressful, and even damaging to ones self esteem
14
Q
coping
A
-“the efforts we take to manage situations we have appraised as being potentially harmful or stressful”
-it continually changes over the course of an encounter
-it consists of what an individual thinks and does in response to the perceived demands of a situation
-Positive coping → adaptation, well-being and maximum social functioning
-inability to cope → maladaptation, ill health, a diminished self-concept, and deterioration in social functioning.
15
Q
problem focused coping
A
-Focuses on changing the relationship between the environment and the person
-Outer - eliminate or alter a situations or another persons behaviour
-Inner - altering one’s own beliefs, attitudes, skills, responses
16
Q
emotion focused coping
A
individuals seek to manage their emotional distress (e.g., through exercise, prayer/meditation, expressing emotions, talking to friends)
17
Q
traumatic stressor
A
“any event (or events) that may cause or threaten death, serious injury, or sexual violence to an individual, a close family member, or a close friend.”
18
Q
acute stress disorder
A
-Occurs within one month of a highly traumatic event (resolving within 4 weeks).
-an individual has experienced, personally or through witnessing others’ experience(s), a severe threat in which life or injury is or appears to be at stake.
-This experience must then continue to affect the individual’s mental health status in such areas as arousal, intrusive memories, and changes in behaviour and functioning.
At least three dissociative symptoms present:
-a subjective sense of numbing, detachment, or absence of emotional responsiveness
-a reduction in awareness of surroundings
-derealization (a sense of unreality related to the environment)
-depersonalization (a sense of unreality or self-estrangement)
-dissociative amnesia
19
Q
post traumatic stress disorder
A
-individual experiences or witnesses an authentic, severe threat of death or injury (including sexual injury) to self or others and this experience then affects the individual’s mental health in specific ways
Major features of PTSD are persistent:
-Re-experiencing of the trauma through recurrent intrusive recollections
-Avoidance of memories of the trauma
-Flashbacks
-Avoidance of stimuli associated with the trauma
-Numbing of general responsiveness
-Increased arousal – irritability, difficulty sleeping, difficulty concentrating, hypervigilance, or exaggerated startle response
-Factors that predict the development of PTSD include being female, type and severity of the trauma, past trauma (including childhood physical, sexual, and emotional abuse), and availability of support at the time of the stressful event
20
Q
treatment for ptsd
A
cognitive–behavioural therapy (CBT)
psychotherapy
eye movement desensitization and reprocessing (EMDR)
medication
21
Q
eye movement desensitization and reprocessing (EMDR)
A
A structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion
22
Q
Intergenerational Transmission of Stress, Trauma, and Resilience
A
-The effects of stress and trauma experienced in one generation can be transmitted to the subsequent generations.
-Adverse experiences in childhood and adulthood may influence
-The transmission of such risk across generations can be mitigated by various protective factors—including internal assets and external resources.
23
Q
collective trauma
A
-Occurs when a traumatic event is experienced by a significant proportion of a given social group. (natural disaster, genocide)
-It can have long-term consequences for the social group beyond its additive effect on individuals such that social norms, dynamics, functioning, and structure of the group may be modified.
-The effects at the family and community levels can modify social norms, dynamics, structures, and functioning that are more than the sum of the individual-level effects
-may be cumulative and be carried forward to subsequent generations
24
Q
historical trauma
A
process by which a social group is affected by the consequences of multiple, collectively experienced adversities across time that outweigh group resiliency factors, become cumulative, and are carried forward to subsequent generations such that the trauma may be considered as part of a single trajectory
25
Responses to Collective and Historical Trauma
-collective approaches will often have the most benefits from a public health perspective when resources are limited
-community-level mental health and psychosocial support interventions have been shown to help communities affected by disasters
-community-based approaches enable interventions to reach a larger target population, as well as undertake preventive and promotional public mental health activities at the same time.
-A long-term goal of historical trauma intervention research and practice is to reduce inequities faced by indigenous people
26
trauma informed care
an approach to all clients that is based on knowledge of trauma and its effects with policies and practices incorporating principles of safety, choice, and control, as well as compassion, collaboration, and trustworthiness
27
nursing care of individuals affected by stress
-Explore recent changes (positive or negative)
-Eliminate or moderate the stressor
-Reduce the effects of stress response
-Development and maintenance of positive coping skills
28
stress interventions
Biologic
-Establish regular routine (eating, sleeping, self care)
-Exercise
-Yoga, meditation, deep breathing, progressive muscle relaxation
-Hypnosis, biofeedback, EMDR
Psychological
-Lifestyle changes
-CBT
-Psycheducation
-Relaxation therapy
-Assertiveness training
Social
-Promote social network
-Educate family
29
crisis
esponse occurs when an individual encounters an obstacle or problem that might affect his or her life goals and that cannot be solved by customary problem-solving methods. It is acute, is time limited, and may be developmental, situational, or interpersonal in nature.
30
situational crisis
-any event that overwhelms an individual’s coping resources and upsets his or her equilibrium
-illness, the death of a loved one, separation or divorce, job loss, school problems, physical or sexual assault, or an unplanned pregnancy
31
developmental crisis
-demands from the social environment exert pressure on an individual to move on to the next developmental stage and that a failure to meet these new expectations precipitates a developmental crisis
-Part of maturation
-leaving home for the first time, completing school, or the birth of one’s first child
32
dissociative disorders
-disruption in the normally occurring linkages between subjective awareness, feelings, thoughts, behaviours, and memories
-Occur after significant adverse experiences or traumas
-Survivors try to avoid people or situations that might provoke memories of the trauma.
-Individuals respond to stress with severe interruption of consciousness
-Unconscious defense mechanism
-Protects individual against overwhelming anxiety through emotional separation
33
examples of dissociation
-derealization and depersonalization (the experience of self or the environment as strange or unreal)
-periods of disengagement from the immediate environment during stress, such as “spacing out”
-alterations in bodily perceptions
-emotional numbing
-out-of-body experiences
-amnesia for abuse-related memories
34
dissociative identity disorder
-(multiple personality disorder)
-Presence of two or more distinct personality states
-Each alternate personality (alter) has own pattern of
Perceiving
Relating to, and
Thinking about the self and environment
Psychotherapy first line
35
dissociative amnesia
-Inability to recall important personal information
-Often of traumatic or stressful nature
-Dissociative fugue - memory loss causes person to end up in an unexpected place, without any memory of how they got there
36
dissociative disorder treatment
Psychoeducation
Pharmacological interventions
Advanced-practice interventions
-Somatic therapy
Evaluation
37
children and adolescents
Children are more likely to be mentally healthy if they have normal physical and psychosocial development and a secure attachment at an early age.
38
The Mental Health Strategy for Canada: A Youth Perspective provided strategic directions for
Promotion
Prevention
Intervention and ongoing care
Research
Evaluation
39
Common Childhood Stressors
-Child → difficult temperament, birth difficulties, extreme sensitivity to sensory experiences, suspected abuse/neglect, loss of caregiver, xtreme activity level, aggressive behaviour, emotional dysregulation, substance use
Family → lacking parenting skills, unresolved trauma, developmental delay, financial and marital problems, chronic health issues, mental health issues, substance abuse, insensitivity, rejection, angry/harsh discipline, frightening behaviour
Residential community → Low SE neighborhood, overcrowding, poor housing, limited access to education, recreation, child care, medical care, etc.
40
mandatory reporting of abuse if
Child is 16 and under
41
#1 type of abuse in children
neglect
42
grief
subjective experience that accompanies the perception of a loss. Children’s grief is shaped by developmental stages as well as experiences.
Children don’t understand permanence of death until age 7
43
personal fable
is an aspect of egocentric thinking in adolescence, characterized by the belief that one is unique and invulnerable to harm. This belief often leads to risk-taking behaviours such as unprotected sex, fast driving, and substance abuse
44
complicated grief
a form of bereavement-related distress that can include such symptoms as being preoccupied with thoughts of the deceased, including difficulty accepting the death, and numbness, bitterness, or a sense of futility
45
primary development task of adolescent
Test different roles and discover who they are
46
protective behaviours for adolescents
problem-solving skills
A supportive family environment,
Environmental supports
cohesive families, schools, and neighbourhoods.
47
Mental Health Assessment of Children and Adolescents
-more specific and fewer open-ended questions
-Simple phrasing
-Artistic and play media (e.g., puppets, family drawings) can be used to engage children
-It is critical to ensure what level of confidentiality can be provided to the youth in the context of an individual interview.
48
Bibliotherapy
use of books, stories, and other reading materials. It can be used to help children, adolescents, and families to gain information and understanding about life stressors, illness, and recovery
49
language disorders
Dyslexia (reading)
Dyscalculia (math)
Dysgraphia (written expression)
50
common features of personality disorders
-Impaired metacognition
-Maladaptive emotional response
-Impaired self identity and interpersonal functioning
-Impulsivity and destructive behaviour
-significant challenges in self-identity or self-direction,
-have problems with empathy or intimacy within their relationships.
-Treatment is difficult and complex, as people with these disorders may have difficulty recognizing or owning the fact that their difficulties are problems of their personality.
51
metacognition
the ability to consider and identify one’s own state of mind and that of others, reflect upon these mental states, and apply this knowledge to problem solving
52
personality disorders comorbidity
-Personality disorders frequently co-occur with disorders of mood and eating, anxiety, and substance misuse
-Personality disorders often amplify emotional dysregulation, a term that describes poorly modulated mood characterized by mood swings
-Life crises of any kind may be risk factors, for instance any grief, loss, or trauma
53
mentalization
The focus of MBT is assisting clients through a therapeutic process to learn about their mental states and then to explore how errors may lead to difficulties.
54
metacognitive interpersonal therapy
validating clients’ experiences and facilitating positive change
55
cluster A (social aversion)
Paranoid personality disorder (PPD)
Schizoid personality disorder (SZPD)
Schizotypal personality disorder (STPD)
-odd or eccentric behaviours(e.g., social isolation, detachment)
-perception distortions, unusual levels of suspiciousness, magical thinking and cognitive distortions
56
Cluster B (dysregulation in emotion and behaviour)
Antisocial personality disorder (ASPD)
Borderline personality disorder (BPD)
Histrionic personality disorder (HPD)
Narcissistic personality disorder (NPD)
-Respond to life’s demands with dramatic, erratic and at times chaotic traits
-Problems with impulse control, emotion processing and regulation, and interpersonal difficulties
57
Cluster C (fearfulness)
Avoidant personality disorder (AVPD)
Dependent personality disorder (DPD)
Obsessive–compulsive personality disorder (OCPD)
- pervasive pattern of anxious behaviours, with:
Rigid patterns of social shyness
Hypersensitivity
Need for orderliness
Relationship dependency
58
Disruptive, Impulse Control, and Conduct Disorders
-characterized by emotional and behavioural self-control problems that lead to violation of the rights of others or bring the person into conflict with societal norms or the authority figures
Intermittent explosive disorder
Oppositional defiant disorder
Conduct disorder
Kleptomania
Pyromania
59
somatic symptom disorder: risk factors
Tends to run in families
Substance abuse
Female gender/sexual abuse
Depression
-A psychosocial history is required to confirm a somatic symptom disorder diagnosis, as well as any comorbid psychiatric disorders.
-People with this type of illness may also have a depressive, psychotic, or an anxiety disorder.
60
munchausen
the most severe form of factitious disorder, which was characterized by fabricating a physical illness, having recurrent hospitalizations, and going from one provider to another
61
intimate partner violence
the perpetrator is a loved and trusted partner or family member.
62
woman abuse
-Many women are afraid or reluctant to identify their abusers
-In some cases, they fear retaliation against themselves or their children
-women of all ages and sociocultural backgrounds may experience abuse
-women who are at higher risk of violence are younger (15 to 24 years of age)
-Indigenous women are at high risk for violence in their intimate relationships
-future patterns of violence and assault are frequently established in early relationships
63
battering
-single greatest cause of serious injury to women.
-repeated physical or sexual violence with the intent of coercive control
-the realistic fear of being killed is one factor that keeps many women from leaving abusive partners
64
sexual abuse: collection of evidence
Likelihood of recovering evidence decreases quickly and is unlikely after 4 hours for prepubescent children and 72 hours for adolescents/adults but we do test adults up to 7 days post assault
65
sexual assault
-Sexual assault is any form of sexual activity with another person without their consent.
-Sexual assault is about power and control being asserted over another person. With sexual assault, a person’s right to determine what happens with their own body, mind, and spirit is taken away.
-47% of all sexual assault incidents reported being against women aged 15 to 24
-a strong association was found between domestic violence victimization and HIV infection
66
abuse of men
-Although women reported severe violence more often than men, men were more than 3.5 times more likely to be the victim of kicking, biting, hitting, or being hit with something
-men may experience the same physical abuse as women, they are less likely to report any negative reactions.
-male victims of sexual assault are more likely to be young, street involved, with an increased vulnerability such as either a cognitive or a physical disability
67
consent
-Any sexual activity without consent is sexual assault and a criminal offence. Consent is a clearly understood agreement between two people; it is an ongoing and active choice and it is revocable (ie. anyone can change their mind). Consent to one sexual activity does not constitute consent to future activity, or other forms of activity. Consent is required each time people are engaging in sexual intimacy or contact.
-Coercion is never a part of consent. This means that someone cannot threaten, pressure or talk another person into sexual activity, or misuse their position of trust or authority.
68
forms of SA
Penetration
Attempted penetration
Oral sex
Fondling
Sex talk
Voyeurism
Exhibitionism
Exploitation
69
Voyeurism
the practice of gaining sexual pleasure from watching others when they are naked or engaged in sexual activity
70
Exhibitionism
urges or behaviors involving exposure of the individual's genitals to an unsuspecting stranger
71
Exploitation
Sexual exploitation is an act or acts committed through non-consensual abuse or exploitation of another person’s sexuality for the purpose of sexual gratification, financial gain, personal benefit or advantage, or any other non-legitimate purpose.
-Example-Non-consensual streaming of images, photography, video, or audio recording of sexual activity or nudity, or distribution of such without the knowledge and consent of all parties involved
72
child abuse
-strong association between child abuse and mental conditions including suicidal ideation
-The most common forms of child maltreatment included witnessing IPV (34%), neglect (34%), physical violence (20%), and emotional neglect (9%)
73
child neglect
-the most common forms of child abuse reported
-Physical neglect occurs when a parent or guardian does not meet a child’s needs such as food, clothing, shelter, cleanliness, health care, or emotional needs
-Can be as harmful as physical abuse
-Indicators of physical neglect may include diaper dermatitis, lice, scabies, dirty appearance, clothing inappropriate for the weather, and unclean and unsafe living environments.
74
physical abuse
-deliberate use of force against a child and may include hitting, slapping, punching, biting, burning, kicking, pushing, shoving, choking, or any other type of physical action directed towards the child that results in nonaccidental injury
-Often, clothing hides these injuries, and practitioners must look for other signs of abuse, such as fear, aggressive or withdrawn behaviour, poor social relations, learning problems, delinquent behaviour, and wearing clothing that is meant to cover injuries but is inappropriate for the weather.
-professionals should suspect abuse when explanations are implausible and inconsistent with injuries, when involved parties give different versions of the incident, or when treatment seeking is delayed
75
child SA
-General age of consent is 16
categories of sexual abuse
-Incest
-sexual abuse perpetrated by a nonfamily member
-Paedophilia
those who have a sexual fixation on young children that usually translates into sexual acts with the victims.
76
indicators of sexual abuse
Physical signs
-Bruising, scratches
Emotional signs
-Irritable, withdrawn, angry, confused
Behavioral problems
-Defiant
Developmental signs
-Potty trained child regressed to incontinence
77
emotional abuse
-Acts or omissions that psychologically damage the child
-Causes disturbed sense of security and self esteem
78
Factitious Disorder Imposed on Another
-intentionally imposing physical or psychological signs or symptoms of an illness in another person, usually a child
-The signs of this disorder include
-repeated hospitalizations and medical evaluations of the child without definitive diagnosis
-symptoms or medical signs that are inappropriate or inconsistent
-symptoms that disappear when the child is away from the parent
-a parent who encourages medical tests for the child
-parental uneasiness as the child recovers
-a parent who is less concerned with the child’s health than with spending time with caregiver
79
Secondary Abuse: Children of Battered Women
-Exposure to violence is a serious stressor for children
-Children who witness violence in the home are more likely to be the victims of childhood abuse as well.
-70% of children who witnessed violence were also victims of physical or sexual abuse
80
Same-Sex Intimate Partner Violence
people who were identified as gay, lesbian, or bisexual were twice as likely as heterosexual individuals to be victims of spousal violence
81
family stress theory
Being a caregiver for an older adult causes stress in the family (economic hardship, loss of sleep, and intrusions into family activities and routines). If there is no relief, the caregiver may become overwhelmed, lose control, and abuse the elder.
82
cycle of violence
1) Tension building
Perpetrator isolates victim, demands total control, degrades victim
2) Violence erupts
Severe injury occurs
3) Remorse Ensues
Perpetrator becomes kind, loving, begging for forgiveness, makes promises never to abuse again
83
Human Response to Trauma (Survivors of Abuse)
Major depressive disorder
Acute stress disorder
PTSD
Dissociative identity disorder
Low self esteem
Guilt and shame
Anger
Problems with intimacy
Revictimization (people abused as children likely to be abused again later in life)
84
“LIVES” approach
Listen
Inquire
Validate
Enhance safety
Support
85
nursing management to abuse
-Trauma informed care
-conducting the assessment in a private setting and reducing the number of professionals who interact with the client.
-all nursing interventions should empower survivors to act on their own behalf and must be done in a collaborative partnership
-nurses must be willing to offer support and information and not impose their own values on survivors by encouraging them to leave abusive relationships
-nurse must remain non judgemental and provide information about available services and emergency numbers
-Establishing a trusting nurse–patient relationship is one of the most important steps in assessing any type of abuse
-Screen everyone for abuse
(a) listen to her story in a nonjudgmental way
(b) affirm she is not to blame
(c) document what the woman reports in her own words
(d) assess her level of risk and discuss safety strategies
(e) conduct a comprehensive health assessment
(f) ask the woman what she needs
(g) discuss referral to services if the woman wishes
-The nurse should thoroughly document all findings
-Injuries should be photographed (need permission)
-If the survivor does not admit abuse, the nurse cannot note abuse in the record
86
documentation of abuse
-Physical examination and history
-Photographs of injuries
-Permission
-Patient quotes
-Discrepancies between patients’ statements and their caregivers or family members
-Confidentiality
-Do not do assessments on patients that are intoxicated
87
Criminalization of persons with mental illness
occurs when persons with an untreated mental illness contravene the law and enter the justice system rather than the healthcare system
88
responsibilities of forensic nurse
-Non-biased, non-judgmental care, while adhering to the pts care while ensuring their abiding by their legal obligations
-Thorough documentation, the odd time attending court
89
Criminalization of the Mentally Ill
-Correctional facilities have become “de facto psychiatric institutions” with “access to psychiatric care only [occurring] after they have been criminalized.”
-Treatment lacking within correctional institutions
-Deinstitutionalization
-Need of provincial and federal funding
-Mental Health Strategy for Corrections in Canada
90
UST (unfit to stand trial)
-the accused is not fully capable of instructing legal counsel or not capable of understanding the nature and the consequences of a trial
-the judge has one of two choices: disposition for detention in hospital or a conditional discharge
-the person, however, can later be found “fit” and tried in court and convicted, or deemed NCRMD
91
NCRMD (not criminally responsible due to a mental health disorder)
-based on the accused person’s mental state at the time the offense was committed
-detention in hospital, conditional discharge, or an absolute discharge
92
Recovery for persons under forensic purview
-clinical recovery through symptom relief
-functional recovery through improving life skills
-social recovery through community reintegration
-personal recovery through achieving life satisfaction despite illness
-offender recovery through a redefinition of self.
93
Youth Criminal Justice Act
governs the prosecution of young persons aged 12 to 17 who are alleged to have committed criminal offences (Ontario, 2023)
94
youth forensic client
-Prone/at risk for MH issues
-Higher rates of anxiety, ADHD, depression, and substance absue
-School, group therapy, socialization with limits
95
The Transgender Forensic Client
-Sexual and physical violence
-More prone to violence and assaults
-Special needs
-May need to ensure the patients are kept safe
-Nursing responsibilities
-Non-judgment, non-biased care
-Current policies dictate that offenders are eligible for surgery only after living as a transgender person in the community (and not prison) for 1 year
96
families of forensic clients
-Forgotten clients - family members of people incarcerated
-Family affair
Effects on:
-Children
-Spouses/partners
-Collaborating with family members is critical to the safe reintegration of the forensic client into the community
97
nurse client relationship: forensic client
-Establishing and maintaining a therapeutic relationship is key
-Engagement in a therapeutic relationship can be especially difficult for nurses when the client is accused (or convicted) of committing a morally reprehensible act
-Clients may engage in threatening behaviours, break rules, and test boundaries, and they are unappreciative of nurses’ efforts in providing health care
-To be successful, forensic nurses need to explore honestly and candidly their own preconceived ideas, attitudes, feelings, beliefs, and stereotypes regarding the forensic client.
98
Common Relationship Issues Experienced by Forensic Nurses
Othering
Boundary violations
Manipulation
99
static security
structural or environmental artifacts common to secure environments, for example, the use of two-way radios, personal protection alarms, video monitoring, electronic door locks, internal barriers, and perimeter fences or walls
100
dynamic security
concerned with institutional policies, staffing patterns, methods of operation, and relational security
101
unrestricted eating
-Healthy eating, exercise, weight, and body image
-Eating and appearance not an issue
102
watchful eating
-Identify as dieter, body builder
-Focuses on food composition and calories
-Calorie counting, tracking exercise
-Modifies calorie intake
-Exercises or trains to change body appearance
103
Increasing weight and shape preoccupation
-Rigidly adheres to food selection and eating patterns
-Insistent calorie counting, preoccupation with food and exercise
-Tracks weight losses and gains
-Yo-yo dieting
-Supplements
-restricts/avoids food intake; binge eating and purging
104
clinical eating disorders
anorexia nervosa
Bulimia
Binge eating disorder
105
Neurobiology, Neurochemistry, and Physiologic Consequences of Anorexia Nervosa
-Diagnosis → semistarvation behaviours, relentless drive for thinness or a morbid fear of becoming fat, and signs and symptoms resulting from the starvation
-ignore body signals or cues, such as hunger and weakness, and concentrate all efforts on controlling food intake.
-Individuals living with AN may avoid conflict; have difficulty expressing negative emotions, especially anger and have an overwhelming sense of shame and guilt.
-With more severe weight loss come other symptoms, such as apathy, depression, and even mistrust of others.
-physiologic disturbances that include cardiac arrhythmias, loss of bone density, neuronal deficits, and hormonal changes (e.g., amenorrhoea, decreased libido)
-Interoceptive awareness is a term used to describe the sensory response to emotional and visceral cues, such as hunger.
106
psychological consequences of anorexia
-Struggles around identity and role, body image formation, sexuality, and maturity fears predominate
-In writing of their experiences with AN, women expressed constant performance anxiety, low self-esteem, depressed state of mind, and self-destructive behaviours, and engaged in self-harm practices of cutting, vomiting, or extreme physical training
107
Thoughts and Behaviours - Anorexia Nervosa
-Terror of gaining weight
-Preoccupation with food
-View of self as fat even when emaciated
-Peculiar handling of food- cutting into small bits, pushing pieces of rood around plate.
-Possible development of rigorous exercise regimen
-Possible self-induced vomiting, use of laxatives and diuretics
-Cognitions so disturbed that individual judges self-worth by his/her weight.
108
refeeding syndrome
-Life threatening
-When someone is malnourished their body metabolizes fats and protein cause there are not enough carbs, once carbs are reintroduced there is a surge of insulin, which causes cellular uptake of phosphate leading to hypophosphatemia
-can lead to leucocyte dysfunction, respiratory failure, cardiac failure, hypotension, arrhythmias, seizures, coma, and sudden death
109
two types of anorexia
restriction
binge purge
110
Thoughts and Behaviours - Bulimia Nervosa
-Binge eating behaviours
-Often, self-induced vomiting (or laxative or diuretic use) after bingeing
-History of AN in one fourth to one third of individuals
-Depressive S&S (low self esteem)
-Problems with; Interpersonal relationships, Self-concept, impulsive behaviours
-Increased levels of anxiety and compulsivity
-Stress precedes the occurrence of bulimic behaviours (often with life transitions, eg. moving out)
-difficulty with setting limits and establishing appropriate boundaries
-they feel ashamed, guilty, and disgusted about binge eating and purging.
-Possible chemical dependency
-Possible impulsive stealing
-Outcomes better for bulimia than anorexia, lower mortality rates
111
Avoidant and Restrictive Food Intake Disorder
- involves limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness.
-ARFID is a mental illness which can severely compromise growth, development, and health.
112
pica
-Pica is characterized by the persistent consumption of non-food items over a period of at least a month.
-Non-food substances may include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal or coal, ash, clay, starch, or ice.
113
rumination disorder
-consistent regurgitation of chewed and/or partially digested food over a period of at least a month. Previously swallowed food is brought up into the mouth effortlessly, with no sign of gagging or nausea.
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Unspecified Feeding or Eating Disorder
This category is used to describe symptoms of a feeding or eating disorder which causes distress and impairment in functioning but does not meet the criteria for anorexia nervosa, bulimia nervosa, binge-eating disorder, OSFED, or ARFID.
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schizophrenia comorbidity
Depression
Diabetes mellitus
Substance use
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schizophrenia - biologic factors
-Having a first degree relative with schizophrenia increases an individuals risk to 10% compared to usual 1% in the population
-Scientists continue to identify genes responsible for schizophrenia
-When one twin has schizophrenia there is a 50% chance the identical twin will also and 15% for fraternal twins
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neurobiological factors - schizophrenia
-Too much Dopamine contributes to psychosis
-Drugs such as Haldol and Chlorpromazine block dopamine
-Other drugs such as Olanzapine and Quetiapine also block serotonin plus dopamine
-Amphetamines, cocaine and methylphenidate all increase the activity of dopamine in the brain and may trigger schizophrenia in biologically predisposed people, or may worsen existing schizophrenia.
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brain structure abnormalities - schizophrenia
-Brain imaging has shown that people with schizophrenia have:
-structural brain irregularities – enlarged lateral cerebral ventricles, dilated third ventricle, ventricular asymmetry, reduced cortical, frontal lobe, hippocampal or cerebellar volumes, increased size of the sulci on the brain surface
-Lower brain volume and more CSF
-Lower rate of flood flow and glucose metabolism in the frontal lobes
-Structural changes may worsen as the disease progresses
-Post mortem studies show reduced grey matter, particularly in the temporal and frontal lobes
-More tissue loss = more symptoms
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Psychological and Environmental Factors - schizophrenia
-Factors that contribute to schizophrenia in pregnancy
-Risk factors include viral infection poor nutrition, hypoxia and exposure to toxins
-Psychological trauma to the mother e.g. death of a family member
-Father over age 35 at time of conception
-Being born in late winter or early spring
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risks - schizophrenia
-Stress increases cortisol levels in the brain which hinders hypothalamic development causing other changes that might cause the illness in susceptible people
-Schizophrenia often occurs at stressful times in a persons life such as
-Cannabis use has been found to increase the risk of schizophrenia
-Exposure to psychological trauma increases the risk of schizophrenia
-Living in poverty or high crime areas
Immigrating to another country
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development of schizophrenia
-Symptoms may appear a month or a year prior to the start of the illness
-Some individuals may have a single episode of schizophrenia and no recurrences, while others have several recurrences and then nothing
-It is considered a recurring and chronic illness
-It cannot be cured but it can be managed
-Preceding traits of individuals with schizophrenia show them to be socially awkward, lonely, depressed, express themselves in odd ways
-The individual may recognize that something isn’t right with themselves
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EPI programs
early psychosis intervention programs
criteria - 1-2 psychotic episodes
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what is DUP?
Duration of untreated psychosis
-As DUP increases patients are less and less able to care for themselves
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4 phases of schizophrenia
Prodromal Phase
Phase I – Acute
Phase II – Stabilization
Phase II - Maintenance
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prodromal phase
-Gradual development of symptoms
-May lose interest in their usual activities
-May withdraw from friends and family
-Become easily confused, have trouble concentrating, feel listless and apathetic
-Prefer to be alone
-May become intensely preoccupied with religion or philosophy
-Usually the active phase follows these symptoms
-Can't diagnose in this phase
-Ex: tension and nervousness, lack of interest in eating, difficulty concentrating, disturbed sleep, decreased enjoyment and loss of interest, restlessness, forgetfulness, depression, social withdrawal from friends, feeling laughed at, more religious thinking, feeling bad for no reason, feeling too excited, and hearing voices or seeing thing
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acute phase
-Psychotic symptoms
-The individual experiences
-Hallucinations
-Delusions
-Apathy
-Withdrawal
-Usually occur following a prodromal period, but sometimes can appear suddenly
-First psychosis usually occurs in adolescence or early adulthood
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stabilization phase
-Symptoms begin to abate
-Gradual return to former level of functioning
-May require hospitalization, or a group home setting
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maintenance phase
-Condition has stabilized
-Symptoms are absent
-No longer requires residential care
-Able to function as they did prior to symptoms appearing
-Lives independently in their own homes
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anergia
lack of energy
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avolition
Reduced motivation re grooming, ADLs
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Poverty of content of speech
speech that lacks meaning, of speech quantity if greater than necessary for the message conveyed
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poverty of speech (alogia)
reduced amount of speech
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blunted
reduced/minimal emotional response, speech lacks inflection
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affective lability
abrupt, dramatic, unprovoked changes in the type of emotions expressed
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ambivalence
the presence and expression of two opposing feelings, leading to inaction
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apathy
reactions to stimuli are decreased; diminished interest and desire
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side effects of antipsychotics
Orthostatic hypotension, hyperprolactinaemia, Gynaecomastia, Galactorrhoea, weight gain
Sedation, Cardiac arrhythmias, Agranulocytosis
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neuroleptic malignant syndrome
-Severe muscle rigidity and elevated body temperatures
-We see hypertension, tachycardia, tachypnea, sweating, incontinence, altered level of consciousness (may be to the point of unconscious/coma), leukocytosis, muscle injury
-Generally seen within the first 2 weeks of being on their meds.
-High mortality rate (33%)
-Recognize early
-Stop neuroleptic meds
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Anticholinergic Crisis
confusion, recent memory loss, agitation, dysarthria, incoherent speech, pressured speech, delusions, ataxia, and periods of hyperactivity alternating with somnolence, paranoia, anxiety, or coma
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acute dystonia
intermittent or fixed abnormal posture of the eyes, face, tongue, neck, trunk, and extremities
-can give anticholinergics to treat
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akathisia
obvious motor restlessness, evidenced by pacing, rocking, shifting from foot to foot, not able to sit still
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waxy flexibility
remaining in a fixed position like wax statue
